management of foreign body in ear
TRANSCRIPT
Learning outcomesAt the end of the online lecture, student should be able to:1.Describe the sign and symptoms children with foreign
body in the ear.2. Identify the type of foreign body correctly.3. Prepare the equipment correctly.4. Differentiate the warning sign of complication .5. Plan the quality nursing care for the patient.6. Recommend health education with confident.
TM SJ 2017
Management and removal of EAR foreign bodies
INTRODUCTION
•FOREIGN BODY, EAR
• Condition where something is present in the ear that is not normally there.
1. Common in children especially toddlers
2. Although they can be found in adults.
SIGN AND SYMPTOMs Ear pain Ear discharge Loss of hearing in one ear Reduced hearing Fretfulness of child Child scratching at the ear
WHERE IT STUCK?• Most foreign bodies will lodge either
lateral to the isthmus or impacted to
the site.
• Located in the deep meatus they may
reside in the anterior recess
TYPE OF FOREIGN BODY
NON-LIVING SPONGE ERASER PAPER WOOD COTTON BUDSLIVING BEANS NUTS WORMS MAGGOTS
BEAD METAL STONES PLASTIC TOYS BUTTON BATERY
ORGANIC INORGANIC
•Nuts beans insect worm
ORGANIC-(living):
ORGANIC-(NON-LIVING) : •sponge wood eraser cotton buds
INORGANIC:
•Metal beads button stone batery
INVESTIGATIONOTOSCOPY
HOW TO REMOVE?
DEPENDS ON THE TYPE OF FOREIGN BODY AND ITS LOCATION .
TECHNIQUE OF TREATMENT
Equipment Otoscope with
removable lens Microscopic otoscope Headlamp Jobson horne hook crocodile forceps Syringe Gauze
Emesis basin suction equipment and
tubbing Magnet for metallic
foreign bodies Ear speculum Zoellner sucker Galipot Olive oil
BLUNT HOOK
useful for round smooth object but not if impacted.
CROCODILE FORCEP
a pairs of crocodile forceps can easily graps objects such as
cotton wool , paper ,pieces of foam sponge and insects.
Should not be use to remove smooth round objects.
MICROSUCTION Suction is satisfactory for the majority of foreign
bodies.
Removal should be perform with an microscope to
avoid trauma to the canal or tympanic membrane
EAR SYRINGING
Ideal for most foreign bodies excepts if vegetable
material and organic type.
Irrigation must be avoid with vegetable material and
organic type because this causes welling of the object
and makes removal more difficult.
INSECTS
Olive oil is used to drown lives insect in the external
auditory.
Crocodile forceps are then used to remove the insect
COMPLICATION1. Acute complications of ear foreign body removal include
canal abrasions, bleeding, infection.
2. perforation of the tympanic membrane.
3. Otitis externa / otitis media
4. Foreign body granuloma
5. Tetanus may occur from sharp infected foreign bodies.
TIPS AND WARNING Repeated attempts at removal are unkind
If foreign is not visual abandon the procedure- ( PLEASE REFER TO DOCTOR )
To be careful during the procedure. TYMPANIC MEMBRANE WILL INJURED
PATIENT’S BACKGROUND
Admit paediatrics ward.
She is 3 yrs old malay girl.
No past medical/surgical history.
PRESENT HISTORY
OUT PATIENT DEPARTMENT
Complaint of left ear discharge for one month. After the
patient having upper respiratory tract infection.
According to mother the girl have insert (scarf beads) in
the left ear and removed by her mother.
Only removed 3 pcs only and complaint still left
1( scarf beads) inside the ear.
CONT: Was refer to Otorhinolaringology, Hospital X.
She was given antibiotic augmentin 10/7 but still no
any improvement.
Hospital X Intan refer again to Hospital Y for futher
management.
PYSICAL EXAMINATIONOUTER PINNA
Bilaterally outer pinna normal
No oedema and redness.
No tenderness
Otoscopy was done .
•-Right ear wax with Tympanic membran intact-Left ear pus with granulation tissue occluding external Aqustic canal, Tympanic membran not visualised for left ear.
TREATMENT
Patient was admitted:
- Start i/v Augmentin 225 mg tds,
-Paracetamol Syrup 225 mg PRN
-To review if not resolving
- KIV for EUA on Thursday
DAILY REVIEW Patient was review and Tarivid ear
drops 3 drops BD Left ear was added.
Contninue medication as ordered
Cont:
Vital signs patient was stable , patient
comfortable with minimal pain,no
bleeding.
After day 5 i/v Augmentin ,patient was
procced for EUA.
PRE - OP For anaest to review, seen by anaest, proceed for EUA as planned.
Keep NBM at 12 MN,
IVD 52 ml/hr Halfsaline Dextrose 5 % once NBM
Blood investigation :
Fbc - normal
Renal Profile - normal
GSH
Consent by mother/father
Vital signs
EUA PROCEED EUM was done after patient sedated
RESULT:
1. No foreign body.
2. Granulation tissue left ear
3. Tympanic membrane perforation
PROGRESS REPORT OF PATIENT
- Afternoon ward round
6 hours post EUM and removal of granulation tissue left ear, patient stable,
no fever, taken orally, complaint of mild dizziness with vomitted once.
-Physical examination done :
Left ear Popewick insitu
No bleeding seen
Plan: continue antibiotic
Continue sofradex
Off ivd once tolerating well
- Patient seen at clinic
EUM left ear - popewick removed
superior perforation of TM seen
granulation tissue seen near TM
popewick reinserted
Plan: patient discharge with medication.
TCA1 week
Syrup augmentin 225 mg bd x 1/52
Syrup PCM 225 mg qid
Taravid ear drop left ear 3 drops bd
Follow up at clinic:After 1 week
Patient well, no fever.
Popewick removed, TM perforation with granulation at TM
smaller ,no pus seen.
Plan : continue popewick
After 2 weeks
Patient well, popewick removed , left ear granulation tissue
less, much improved
Plan : continue ear drop
After 3 weeks
Patient defaulted TCA
NURSING DIAGNOSIS
AND
NURSING INTERVENTION
Potential infection related to deficit knowledge regarding ear care .
Obj: No infection and patient understand about ear care
1. Keep ear dry to avoid infection because wet is good place
for microrganism to spread .
wear ear plug while bathing
Put cotton wool wet with olive oil in ear while bathing
to avoid water getting inside the ear.
No swimming or diving.
2. Wipe the external ear after bathing with dry soft
towel.
3. Dont put any tradisional medicine in ear to avoid
infection.
4. Don’t dig the ear with cotton bud because can cause
trauma to ear canal and the cerumen will become
impacted and will be infected.
1)
Fear and anxiety related to procedureObjective : patient told the fear and anxiety reduced
1. Talk with patient smoothly, for patient not to afraid of doctors
and nurses.
2. Tell the procedure to patient , for patient co-operation.
3. Ask mother to always beside with patient for moral support,
and not fear .
health education before discharge
health education
1. Wipe the outer ear with a dry cloth or tissue to
dry the ear.
2. Do not use cotton bud to clean the ear canal,
it’s cause trauma and the
cerumen will become impacted.
3. Do not use pins or sharp pointed objects to
clean your ears, because these objects may
injured the ear canal or eardrum.
4.Tell the patient , do not put anything into ear
and nose, it’s cause trauma and infection .
5.Tell the parents, treating upper respiratory
infections promptly to reduce the risk of ear.
6. See doctor or come to hospital immediately
if sign and symptom of infections e.g. redness,
fever, pain, ottorhea for early treatment.
Cont:
Cont:7. Choose a suitable play toys for your children to make sure the
safety.
8. Seek the doctor if you notice foreign body insitu for early
treatment .
9. Continue follow up to clinic regularly as ordered to review the
progress of .
treatment.
10. Continue take medication as ordered especially antibiotic to
avoid resistant to antibiotic.
ANY QUESTION?
THANK YOU
THANK YOU